Outline

Objective

Infratentorial craniotomies may be performed in the semi-sitting position if a patent foramen ovale is excluded. The major complications reported in the literature are venous air embolism and prolonged ICU course with extended extubation time. We evaluated the patient data to asses the incidence and severity of VAE and other major complications using a protocol with standardized positioning and transesophageal echocardiographic monitoring during the intervention.

Methods

187 Patients were operated in the semi-sitting position between 1999 and 2004 and were monitored intraoperatively using a transesophageal echocardiographic examination. The data were collected retrospectively from the charts of the patients for the incidence of air embolism and other complications related to positioning.

Results

The mean age of the patients was 51,4 (Â±16,4) y, the mean operation time was 4,3 (Â±1,9) hours. Only 3 (1,6%) cases of venous air embolism occurred and air could be aspired from the central line in 187 patients. Only one case was hemodynamically relevant with temporary arterial blood pressure decrease and heart rate increase. Pneumatocephalus leading to lethargy was a frequent postoperative finding, which resolved spontaneously without morbidity. One case with an epileptic seizure and N. III affection due to subdural trapped air had to be treated surgically. There was no permanent morbidity or mortality in our study related to the semi-sitting position.

Conclusions

Using transesophageal echocardiografic monitoring and a standardized positioning, posterior fossa craniotomies in the semi-sitting position can be performed safely.